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Dupuytren's Contracture (Hypodontia)

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  3. Dupuytren's Contracture (Hypodontia)

Overview of Dupuytren's Contracture (Hypodontia)

Dupuytren’s contracture is a deformation of fingers due to the formation of nodules or knots beneath the skin. These nodules make the thick cord under the skin that pulls one or more fingers in a bending position.  It affects any finger but mainly the ring and little fingers. Along with fingers, it also has an effect on the palm.

These bent fingers majorly affect everyday activities such as wearing gloves, shaking hands, or placing hands in pockets.

Prevalence of Dupuytren's Contracture

In Pakistan, Dupuytren's contracture rate is high in males, with diabetes, poor glycaemic control, and microvascular complications patients.  About 40% of patients were reported with static diseases, 50% progression, and 10% regression. About 15-45% of people suffered from diabetes.

Signs and Symptoms of Dupuytren's Contracture (Hypodontia)

The signs of Dupuytren disease are divided into three phases:

  • Nodules- The first symptom of Dupuytren's disease is nodule formation under the skin in the palm. Nodules are tender and sore and cause some irritation in hand.  Over time, the irritation eventually goes away.

  • Cords- If a person does not treat the nodules, it extends to form a tough band of tissue under the skin of the palm. These hard bands are called cords that turn the fingers into a bending position. 

  • Contracture- As the cords are left untreated, it results in an abnormal loss of muscle tissue that leads to permanent disability. The affected people have a problem with picking up large objects or putting their hands in their pockets.

Types of Dupuytren's Contracture (Hypodontia)

Causes of Dupuytren's Contracture (Hypodontia)

The cause of the disease is unknown, but some biochemical factors increase the risk of Dupuytren’s contracture.

  • It is more affected in males than females
  • People between 40 and 60 years of age are at high risk of getting this disease
  • The Dupuytren’s contracture is highly prevalent in Northern European descent 
  • The people who have a family history of the condition (Dupuytren’s contracture hereditary)
  • Due to excessive smoking
  • To drink a lot of  alcohol
  • People who have diabetes can easily affect Dupuytren's contracture

Note: It cannot be caused by overusing hands such as during a job or repetitive motions of hands and hand injuries.

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Risk Factors of Dupuytren's Contracture (Hypodontia)

Certain risk factors associated with Dupuytren's contracture include:

  • Age: The problem usually affects people at least 50 years of age.
  • Gender: Men, compared to women, have a greater chance of suffering from Dupuytren’s contracture.
  • Family History: There are greater chances of suffering from the problem if the problem runs in your family.
  • Ethnicity: People from Northern European backgrounds are more likely to suffer from the disease.
  • Diabetes: The problem is more common and severe among people who are diabetic.
  • Smoking and Drinking: If you smoke or drink, you definitely have a higher chance of suffering from the problem as it can affect the blood supply to your hand. 

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Prevention

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Diagnosis

Mostly, doctors diagnose Dupuytren's contracture by looking at and touching the hands to the affected area. They will compare the hands to each other and check the pulled area of the palm’s skin. Also, press the areas of the hands and fingers for checking the toughened knots or bands of tissue.

There are also other ways to check the hand's deformity like putting the hand on flat surfaces. If it is not fully flattened, it means a person may have Dupuytren’s contracture.

Treatment of Dupuytren's Contracture (Hypodontia) | When to Consult a Doctor

Treatment involves different therapies that allow the hands to move freely but if the disease is not progressed quickly.

The removing or breaking apart of the cords helps to recover the pulling of fingers toward the palm. This can be achieved in several ways. A doctor recommends the treatment according to the severity of symptoms and other health complications if any.

Treatment options may include:

  1. Needling

In this technique, a doctor uses a needle, inserted through the skin, to puncture and break the cord of tissue. In this way the bending area of fingers is treatable. In some cases, contractures may recur. For this, the whole procedure has to be repeated.

The positive aspect of the procedure is that there is no need for the incision of several fingers at the same time. Afterward, physical therapy is required. 

The negative aspect is that this technique is not applicable in those areas of fingers that connect with nerves or tendons.

  1. Enzyme Injections

Injecting, the enzyme solution into the area of the palm helps to soften and weaken it. This helps to break and straighten the cord of the fingers.

The FDA-approved collagenase Clostridium histolyticum (Xiaflex) is used for this procedure. The advantages and disadvantages of the enzyme injection are like needling (as aforementioned). This technique is not performed at all hospitals.

  1. Surgery

If the disease affects most of the areas of fingers and palms then the last option is surgery.

A doctor surgically removes the affected tissue within the palm. The main advantage of surgery is that the treatment is long-lasting as compared to the needle or enzyme methods. The main disadvantage is that recovery takes a lot of time because of physical therapy after surgery. 

In most severe cases not only the finger area is affected but also tendons or nerves along with it. In that case, a skin graft helps to cover the open wound. This type of surgery is the most invasive and has the longest recovery time. After this, people often take months or more for intensive physical therapy.

In case you exhibit any concerning signs and symptoms of Dupuytren’s contracture, consult a medical specialist as soon as possible.

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